Healthcare Provider Details

I. General information

NPI: 1902135395
Provider Name (Legal Business Name): ALYSSA LEE NATALINO R.D.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PHOENIX AVE SUTIE 201
WATERBURY CT
06702-1418
US

IV. Provider business mailing address

80 PHOENIX AVENUE SUTIE 201
WATERBURY CT
06702
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-8021
  • Fax: 203-596-9038
Mailing address:
  • Phone: 203-756-8021
  • Fax: 203-596-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number007172
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: